Permit CITY OF TIGARD MECHANICAL PERMIT
rm • • COMMUNITY DEVELOPMENT Permit#: MEC2013-00591
T I G A.R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/08/2013
Parcel: 1 S125DA01900
Jurisdiction: Tigard
Site address: 9130 SW 69TH AVE
Project: WEAVER Subdivision: KINGS VIEW Lot: 4
Project Description: Gas fireplace insert installation.
Contractor: OWNER Owner: WEAVER, HAROLD B
9130 SW 69TH AVE
TIGARD,OR 97223
PHONE: PHONE:
FAX:
FEES
Specifics: Description Date Amount
Wood Fireplace/Insert - 10/08/2013 $23.32
Type of Use: SF 12%State Surcharge-Mechanical 10/08/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 10/08/2013 $66.68
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure: •
• Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
AIM
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
Mechanical Permit Application FOR order: use oiNI 1' ,
City of Tigard �� Received Permit No.:
hr g Date/By: 10/10l 3 - /1 c.20 3— q/
.514 ° 13125 SW Hall Blvd.,Tigard,OR 97223
C Plan Review
Phone: 503.718.2439 Fax: 503.598.1'4-: �, ,�� e/By: Other Permit:
Inspection Line: 503.639.4175 �r`'
T I G R D t 1. l� Date Ready/By: Juris ' ® See Page 2 for
Internet: www.tigard-or.gov �� IA% Notified/Method: -��� Supplemental Information
O 0��,�,\SX COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
TYPE OF WORK, G� Mechanical permit fees*are based on the value of the work
®Addition/alteration/ tent performed.Indicate the value(rounded to the nearest dollar)of all
❑New construction mechanical materials,equipment,labor,overhead,and profit.
❑Demolition ❑Other. Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For spedal informal/on use checklist
Description I Qty. I Ea. I Total
❑ Multi-family ❑Master builder ❑Other:
Heating/cooling:
JOB SITE INFORMATION AND LOCATION Air conditioning 46.75 _
Job site address:9130 SW 69h Ave Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard/OR/97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump . 61.06
Suite/bldg./apt.no.: Project name' llv` etl c r., Duct work 23.32
Hydronic street/directions to job site:Taylors Ferry Rd ti hot water system 23.32
Residential boiler r er(radiator ator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Other: 23.32
Subdivision: Lot no.: Other fuel appliances:
Tax map/parcel no.:1S125DA-01900 Water heater 23.32
Gas fireplace/insert 1 33.39 33.39
DESCRIPTION OF WORK Flue vent for water heater or gas
Install Natural Gas Fireplace Insert fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
® PROPERTY OWNER I ❑ TENANT Environmental exhaust and ventilation:
Range hood/other kitchen
Name:Harold Baird Weaver equipment 33.39
Address:9130 SW 69th Ave Clothes dryer exhaust 33.39
Single-duct exhaust(bathrooms,
City/State/ZIP:Tigard/OR/97223 toilet compartments,utility rooms) 23.32
Phone:(503)244-4457 Fax:(503)296-2449 Atticicrawlspace fans 23.32
Other: 23.32
® APPLICANT ❑ CONTACT PERSON Fuel piping:
Business name: $14.15 for first four;$4.03 for each additional
Contact name:Harold Baird Weaver Furnace,etc.
Gas heat pump
Address:9130 SW 69th Ave Wall/suspended/unit heater
City/State/ZIP:Tigard/OR/97223 Water heater
Fireplace 1 1'i,/r
Phone:(503)244-4457 Fax::(503)296-2449 Range
E-mail:haroldweaver56®gmaiLcom Barbecue
Clothes dryer(gas)
CONTRACTOR
Other:
Business name:Home Owner(Harold Weaver) MECHANICAL PERMIT FEES"
Address:9130 SW 69th Ave Subtotal 0 7• 91y
Minimum permit fee($90.00) ''().(/c)
City/State/ZIP:Tigard/OR/97223 Plan review(25%of permit fee)
Phone:(503)244-4457 Fax:(503)296-2449 State surcharge(12%of permit fee) U .)-37)
TOTAL PERMIT FEE /a)..31)
CCB lic.:N/A This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: ----"W • Fee methodology set by Tri-County Building Industry Service Board
Print name:Harold Weaver pjCGJ,,...._-- Date: 10/08/2013
•
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325(2))
This statement is required for residential building, electrical,mechanical,and plumbing per mits.
Licensed architect and engineer applicants,exempt from licensing under ORS 701.010(7), need not
submit this statement.This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that a II subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
r
I will be performing work on property I own, a residence that I reside in, or a residence that I w ill
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this hom eowner statement is true and accurate.
l-�/�nvL0 /.c>CAVWrt-
Print Name of Permit Applicant
/O — 8 —/3
Signature of Permit Applicant Date
•
Permit#: P1PC-e2-613-0059/
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Address: o SO q ib• :: 1-\f'•!
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Issued by: R I - Date: /0/rfi3 t•1'
This Copy for Permit Offices